Making Notes

Documenting workplace conflicts

Tape recording

The laws about tape recording conversations vary from one jurisdiction to another. Regardless of the law, you should not electronically record a conversation without the prior consent of all of the parties involved.

Tape recorders can be used to make notes 'on the
fly' and may be the most convenient way to record an
incident during a busy day in class or on the ward.
However, you must transcribe the recorded notes
because

it is easier to refer to and compare
different parts of written notes than to skip
back and forth through an audio tape;

written notes can be reviewed by others;

written notes can be consulted while you are
giving evidence at a hearing;

audiotapes can be damaged or erased.

Transcription is an exacting and time-consuming
process, so it is not wise to let untranscribed
tapes accumulate.

The laws about tape recording conversations vary
from one jurisdiction to another. Regardless of the
law, you should not electronically record a
conversation without the prior consent of all of the
parties involved. Moreover, you should not
tape conversations, even with consent, except in
very unusual circumstances. Bringing out a tape recorder will almost always
be perceived as an indication of distrust. People may well take offence to
it, and giving offence is not conducive to resolving conflicts. (Interviews
with reporters constitute very unusual circumstances.)

Materials

In a pinch, notes can be made on shirt sleeves,
napkins, matchbooks or Visa receipts. However, a
pocket notebook or some kind of bound journal is the
preferred medium, and hastily scribbled notes should
be transferred to it as soon as possible. Computers
and similar devices can be used, but a current
backup file should always be kept separate from the
device as insurance against hard drive failure or
theft. What follows assumes that some form of bound
notebook will be used in most cases.

Structure of the notebook

Much will depend upon your
credibility, and your credibility may hinge on the
reliability of your notes, including the
demonstrable integrity of your note-taking.

Notes cannot always be made at the time of an
incident or conversation. They often have to be
written a few minutes later, or even a couple of
hours later. Especially when under pressure, people
make mistakes when writing notes. They become
confused about a date or time; write one word when
they mean another; write three lines, and then
remember something else that was said between the
first and second line.

Much will depend upon your credibility, and your
credibility may hinge on the reliability of your
notes, including the demonstrable integrity of your
note-taking. You can structure your notebook and
adopt consistent note-taking habits so that you will
be able to explain the construction of your notes at
any time. You are then less likely to be confused or
shaken by questions about when the notes were
written, or why or when corrections were made. [See
illustrations]

When to record

Ideally, you should make notes at the time that
any incident, conversation or observation suggests
to you that your conscientious convictions are in
issue. However, you may be unable to do so, as
others may be present, or you may be busy. In that
case, make the notes as soon as possible thereafter:
between patients, at coffee, at lunch, etc.

Notes made nearer in time to
an incident will be considered more reliable than
notes made later. This is especially true if
something else happens between the incident and the
note making that might give someone a motive to
slant or falsify the record.

Notes made nearer in time to an incident will be
considered more reliable than notes made later. This
is especially true if something else happens between
the incident and the note making that might give
someone a motive to slant or falsify the record. If
you see a patient in the morning and decline to
provide procedure X, are confronted by a colleague
in the afternoon, and make your notes about the
incident in the evening, it will probably be argued
that your notes are unreliable because you only made
them up as a result of your worries about points
raised by your colleague. The same could not be said
of notes made as a matter of course immediately
after the patient interview.

Of course, if the later conversation with your
colleague makes you aware that certain aspects of
the patient interview need to be more fully
addressed, you can do that by making notes of your
conversation with your colleague and of the required
clarifications. The original notes of the patient
interview should be left intact. This is a natural
kind of development that most people will be able to
recognize from their own experience.

How to record

Use a pen, not a pencil (unless nothing else can
be had). Since these are your notes, you are free to
use any shorthand method or symbols you prefer. Make
sure your notes are legible, as you may have to
refer to them months later.

It may be possible to make some notes during a
conversation, without introducing an element of
distrust or confrontation. For example, if your
preceptor refers to a particular research paper or
book, it would be natural to ask for the title or
citation and write it down.

What to record

In addition to the date and time of the incident
it will be helpful to record the location and names
of other persons present.

Notes are notes, not mini-essays. They are used
to refresh your memory when writing a detailed
account of the incident later, when discussing the
situation with someone else, or when giving
evidence. Notes should primarily record key
information.

In cases of coercion or discrimination arising
from conscientious objection, it is likely that what
you said or what someone else said will be of great
importance. Special attention must be paid to making
notes of the verbatim content of
conversations. Consider the following dialogue:

Pt: "If you won't do it, refer me to
someone who will."

Dr: "I'm afraid I won't do that,
either. If I help someone to do something that I
think is wrong, I would share responsibility for
it."

Pt: "How could you be responsible?"

Dr: "It would be like me helping
someone to rob a bank by giving him the plans of
the building and directions to get there."

Pt: "Bank robbery is illegal. This
isn't."

Dr: "It isn't illegal. But I consider
it to be wrong, so I don't want to be involved
with it."

If later asked to write down what was said, or,
at a hearing, to relate what was said, it is very
likely that the parties to the conversation would
produce accounts from two different perspectives in
the following form:

Pts. Account

Drs. Account

She said she would refuse to help me
find another doctor because what I was
doing was wrong, like bank robbery. If
she referred me she would be just as
guilty as me for doing it. She wouldn't
help a bank robber, and she wouldn't
help me.

I told him that I would not amputate
a healthy limb, nor refer him to someone
who would. I explained that it would be
wrong for me to refer him to someone
else, and used the example of aiding and
abetting a bank robbery to make the
point.

. . .while these paraphrases
are honest interpretations of what was actually
said, they fail to accurately convey the full sense
of the exchange. Important nuances are lost.

The problem is that, while these paraphrases are
honest interpretations of what was actually said,
they fail to accurately convey the full sense of the
exchange. Important nuances are lost. Someone
hearing the patient's account might conclude that
the physician was moralizing or overbearing, and
there isn't enough detail in the physician's account
to preclude this conclusion.

The example should suffice to illustrate the
importance of making notes that allow a conversation
to be reproduced as nearly as possible in its
original form. This enables one to draw conclusions
from what was actually said, rather than from what
could be self-interested paraphrases of a
discussion.

You can use a personal shorthand when making
notes of a conversation, but you should make the
notes in the form of the dialogue, including
important statements or phrases verbatim and
enclosing them in quotation marks. If you are not
sure that your record is exactly right, word for
word, you can use the following form (drawing from
the example above):

"Bank robbery is wrong. This isn't."[WTE]

WTE signifies, "or words to that effect." It
means that you have reproduced the actual words as
best you can, but, if there is a minor error in your
recollection, you have accurately conveyed the
meaning.

Recapitulation

In some cases you may be able to make a few notes
at the time of an incident, perhaps recording
several different things very briefly. You may not
be able to make detailed notes until later. At that
time, you should make an entry headed, "Recap," and,
referring back to your brief notes, expand them to
capture all of the relevant information. If you are
interrupted, continue the recapitulation at the next
opportunity, again identifying the entry as
retrospective.

Narrative expansion

Using your notes, an important incident or
conversation should be expanded to a full narrative
while it is fresh in your mind, including details
about manner of expression, emotion, and other
things that one might not include in notes about the
essentials. The expanded narrative may prove to be
particularly important later. You can use a tape
recorder to dictate an expanded narrative, but be
aware of the need to transcribe the tape and the
time that will be required to do so.